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PP144. Profile of lupus pregnancy in internal medecine practice
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
PP143. Relationship between mid-pregnancy placenta growth factor and hemodynamics in the mother, fetus, and uterus D.A. Woelkers *, R. Ghashghaei, K. Klisser, T. Archer (Reproductive Medicine, University of California, San Diego, United States) Introduction: Placental Growth Factor (PlGF) is an angiogenic and vasoregulatory peptide member of the vascular endothelial growth factor family. Reduction of free, circulating PlGF is associated with preeclampsia and fetal growth restriction, and precedes the clinical manifestations of disease by several weeks. It is not known whether aberrant PlGF is related for alterations in endothelial vascular function that cause or exacerbate the placental syndromes of pregnancy. Objectives: We sought to determine if mid-pregnancy PlGF was related to, and possibly mediating, measures of maternal, fetal, or uterine hemodynamic function in women at risk for placenta-mediated complications of pregnancy. Methods: We measured free plasma PlGF (Triage PlGF Assay, Alere, Inc.) between 22 and 25 weeks in high risk subjects referred for assessment of fetal growth and uterine artery Dopplers due to abnormalities of serum screening analytes or other risk factors for preeclampsia. Maternal hemodynamic parameters including mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR) and index of contractility (ICON) were measured in recumbent position with noninvasive electrical cardiography (Aesculon EC System, Cardiotronics, Inc.). Doppler measurements of blood flow in the uterine arteries (pulsatility index, PI) and umbilical artery (systolic:diastolic ratio, S/D) were obtained by ultrasound (Voluson E8, GE Healthcare, Inc.), along with the estimated fetal weight (EFW). PlGF was expressed as the log concentration, plotted against the hemodynamic measurements, and analyzed with Spearman’s correlation coefficient, R. Statistical significance was set to p = 0.05. Results: Data from seventeen fully studied patients were analyzed. The median gestational age was 24.3 weeks. PlGF concentration ranged from 25 to 1180 with a median of 235 pg/ml. PlGF was positively related to maternal cardiac index (R = 0.56, p = 0.02) and ICON (R = 0.51, p = 0.04) and negatively related to SVR (R = 0.48, p = 0.05). There was a non-significant negative correlation with MAP (R = 0.41, p = 0.10). PlGF showed a positive correlation to EFW (R = 0.52, p = 0.03) and a negative relationship to umbilical artery S/D ratio (R = 0.42, p = 0.06). There was no correlation between maternal PlGF and uterine artery Doppler PI (R = 0.19, p = 0.46). Conclusion: The concentration of circulating free PlGF at mid-pregnancy is related to both maternal systemic hemodynamic function and fetal umbilical artery resistance (and growth) in high risk pregnancies prior to the onset of preeclampsia. It is not, however, related to vascular resistance in the uterine artery. PlGF may play a role in modulating the general vascular function of the fetus and mother after establishment of the uteroplacental circulation. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.254
317
PP144. Profile of lupus pregnancy in internal medecine practice T. Haddad *, D. Hakem, A. Berrah (Internal Medicine, Bab-ElOued Hospitaal Universitary Centre, Algiers, Algeria) Introduction: The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome ‘APLS’ is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. Objectives: To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. Methods: it’s a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). Results: On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21–41), SLE evolve with an average of 2.5 years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient’s. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive chronic renal Insufficiency (1). The specific events observed are a HELLP syndrome (1), pre-eclampsia (2), fetal losses (5), ischemic strokes (4) and post-partum cardiomyopathy (1). The pregnancies require caesarians (15) with ligature of trunks (2). We deplore fetal deaths (7) in tripled (1) and in twin (1) during the period of follow-up. We note a small birth weight (7), a preterm birth (5), a foetal distress (5) at the origin of a psychomotor disorders (1) and we observed a case of a transient skin lupus (1). Conclusion: The frequency of the maternal and fetal complications is partially understandable by the fact that the majority of the pregnancies neither are programmed, nor authorized by the treating physician. Indeed, between the denial of the disease and the desire of pregnancy in everything taken, the patients often take the risk and put the treating physician in front of pregnancies in top risks.
318
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.255
PP145. Hypertensive disorders of pregnancy: A two year study (2008–2009) E. Landim *, A.F. Caeiro, A.V. Santos, G. Dias, I. Santos, T. Matos, A. Nazaré (Department of Obstetrics, Hospital Prof. Fernando Fonseca, Lisbon, Portugal) Introduction: The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. According to the group studies of NHPBEB 2000 four entities are defined: Chronic Hypertension (CH) previous to pregnancy, Gestational Hypertension (GH), Preeclampsia/ Eclampsia (PE/E) and superimposed Preeclampisa/Eclampsia in Chronic Hypertension (PE/E CH). All this entities have different outcomes and require adequate follow-up and specific attitude. Objectives: Review all cases of hypertensive disorders in a two-year period, its incidences, and related maternal and fetal complications. Methods: In a retrospective study, from January 2008 to December 2009, all files related with hypertensive disorders, seen in our department, were reviewed. The statistic analysis was based on Excel 2007. Results: The global incidence of hypertensive disorders was 3.8% (309 cases), with each entity with an incidence of: 40% in CH, 40% GH, 25% PE/E and 7% PE/E CH. In terms of demographic characteristics the majority of the population were caucasian (46%) and black (40%), the mean age was of 31 years (minimum of 12-maximum of 47), and mainly previous Chronic Hypertension and endocrinologic disorders as co-morbidities (Diabetes Mellitus, obesity and thyroid pathology). The fetal/maternal complications were mainly preterm delivery (26.2%), with a low percentage of Abruptio Placentae (1%). Maternal complications were analysed in terms of ICU admissions of 7%, cardiovascular/renal disorders of 1% and maternal bleeding 1%. No maternal death was described. Fetal outcomes were also studied, specifically in terms of birth weight, with an average of 2794 (500–5480 g), apgar index in 1st and 5th minute below seven in respectively, 14% and 3.5%. Conclusion: The incidence of maternal complications in our analysis was lower than described in literature. The incidence of preterm delivery was similar to that reported in other studies, mostly due to late pre-terms (>32 w). Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.256
PP146. Psychological assessment of renal transplant recipients during pregnancy V.L.L. Belardi Neto *, L.G. de Oliveira, N. Sass (Obstetrics Department, Federal University of São Paulo, São Paulo, Brazil)
Introduction: Although many centers have reported their experience on maternal and perinatal outcomes in renal transplant recipients. Very few information can be found about the psychological aspects that may rise for these patients during pregnancy. Considering the importance of the psychological concerns for this kind of patients, we have developed a protocol to better assist renal transplant recipients during pregnancy and here we show what we have learnt. Objectives: To understand how the maternal concerns are seen from renal transplant recipients in terms of psychological aspects. Methods: Fifteen pregnant kidney transplanted women with an average age of 27.5 years were included in the study. All patients have been investigated beyond the 20th week of pregnancy to delivery. The study is cross-sectional, qualitative, and participation is based on developed phenomenological method. Final data analysis will be done through thematic analysis and hermeneutics of meaning. The only exclusion criteria were the current presence of psychiatric disorders or use of drugs that could influence cognitive and emotional aspects during the psychological evaluation. Results: During the last two years we have observed in these women that all of them are aware of the risks of pregnancy after transplantation. Qualitative aspects were: Pregnant with kidney transplantation show: in relation to pregnancy, the desire to be mothers, to give a son to her husband, to become a healthy person again; they believe that conception is God’s will, they have fear of pregnancy, ambivalence of feelings (fear and happiness). In relation to the graft, they reported fear of baby malformations, fear and anguish of graft loss, still consider it worth the risk of having the baby, and some women name the graft, if it were another infant. In relation to delivery, state anxiety and anguish at the proximity of labor (fear of labor pain, anesthesia, cesarean section, vaginal delivery and the ‘‘psychic pain’’). Conclusion: Pending the final results of this study, we still observed that these patients and their husbands require multidisciplinary monitoring since the beginning of pregnancy. Factors religious, cultural and psychic are involved in the desire to be mothers. Disclosure of interest: None declared
doi:10.1016/j.preghy.2012.04.257
PP147. Prevalence of hypertensive syndromes according to pregnancy age G.M. Dias 1, A.M. Godoi 1, M.R.L.N. Paltronieri 1, 1 1 2 R.P. Soares , S.F. Toledo , M.R.F. Curty , V. Tarricone Jr. 1, M.L.C. David 1, F.L.P. Sousa 1, J.M. Garcia 1,*, R.G.R. Guidoni 1, J.R. Del Sant 3, D.R.A. Porto 3 (1 Obstetrics, UNILUS – Lusíada Foundation/Faculty of Medical Sciences of Santos, Santos, Brazil, 2 Obstetrics, Maternity Hospital Leonor Mendes de Barros, São Paulo, Brazil, 3 Obstetrics, Guilherme Álvaro Hospital, Santos, Brazil)
PP143. Relationship between mid-pregnancy placenta growth factor and hemodynamics in the mother, fetus, and uterus D.A. Woelkers *, R. Ghashghaei, K. Klisser, T. Archer (Reproductive Medicine, University of California, San Diego, United States) Introduction: Placental Growth Factor (PlGF) is an angiogenic and vasoregulatory peptide member of the vascular endothelial growth factor family. Reduction of free, circulating PlGF is associated with preeclampsia and fetal growth restriction, and precedes the clinical manifestations of disease by several weeks. It is not known whether aberrant PlGF is related for alterations in endothelial vascular function that cause or exacerbate the placental syndromes of pregnancy. Objectives: We sought to determine if mid-pregnancy PlGF was related to, and possibly mediating, measures of maternal, fetal, or uterine hemodynamic function in women at risk for placenta-mediated complications of pregnancy. Methods: We measured free plasma PlGF (Triage PlGF Assay, Alere, Inc.) between 22 and 25 weeks in high risk subjects referred for assessment of fetal growth and uterine artery Dopplers due to abnormalities of serum screening analytes or other risk factors for preeclampsia. Maternal hemodynamic parameters including mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR) and index of contractility (ICON) were measured in recumbent position with noninvasive electrical cardiography (Aesculon EC System, Cardiotronics, Inc.). Doppler measurements of blood flow in the uterine arteries (pulsatility index, PI) and umbilical artery (systolic:diastolic ratio, S/D) were obtained by ultrasound (Voluson E8, GE Healthcare, Inc.), along with the estimated fetal weight (EFW). PlGF was expressed as the log concentration, plotted against the hemodynamic measurements, and analyzed with Spearman’s correlation coefficient, R. Statistical significance was set to p = 0.05. Results: Data from seventeen fully studied patients were analyzed. The median gestational age was 24.3 weeks. PlGF concentration ranged from 25 to 1180 with a median of 235 pg/ml. PlGF was positively related to maternal cardiac index (R = 0.56, p = 0.02) and ICON (R = 0.51, p = 0.04) and negatively related to SVR (R = 0.48, p = 0.05). There was a non-significant negative correlation with MAP (R = 0.41, p = 0.10). PlGF showed a positive correlation to EFW (R = 0.52, p = 0.03) and a negative relationship to umbilical artery S/D ratio (R = 0.42, p = 0.06). There was no correlation between maternal PlGF and uterine artery Doppler PI (R = 0.19, p = 0.46). Conclusion: The concentration of circulating free PlGF at mid-pregnancy is related to both maternal systemic hemodynamic function and fetal umbilical artery resistance (and growth) in high risk pregnancies prior to the onset of preeclampsia. It is not, however, related to vascular resistance in the uterine artery. PlGF may play a role in modulating the general vascular function of the fetus and mother after establishment of the uteroplacental circulation. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.254
317
PP144. Profile of lupus pregnancy in internal medecine practice T. Haddad *, D. Hakem, A. Berrah (Internal Medicine, Bab-ElOued Hospitaal Universitary Centre, Algiers, Algeria) Introduction: The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome ‘APLS’ is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. Objectives: To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. Methods: it’s a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). Results: On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21–41), SLE evolve with an average of 2.5 years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient’s. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive chronic renal Insufficiency (1). The specific events observed are a HELLP syndrome (1), pre-eclampsia (2), fetal losses (5), ischemic strokes (4) and post-partum cardiomyopathy (1). The pregnancies require caesarians (15) with ligature of trunks (2). We deplore fetal deaths (7) in tripled (1) and in twin (1) during the period of follow-up. We note a small birth weight (7), a preterm birth (5), a foetal distress (5) at the origin of a psychomotor disorders (1) and we observed a case of a transient skin lupus (1). Conclusion: The frequency of the maternal and fetal complications is partially understandable by the fact that the majority of the pregnancies neither are programmed, nor authorized by the treating physician. Indeed, between the denial of the disease and the desire of pregnancy in everything taken, the patients often take the risk and put the treating physician in front of pregnancies in top risks.
318
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.255
PP145. Hypertensive disorders of pregnancy: A two year study (2008–2009) E. Landim *, A.F. Caeiro, A.V. Santos, G. Dias, I. Santos, T. Matos, A. Nazaré (Department of Obstetrics, Hospital Prof. Fernando Fonseca, Lisbon, Portugal) Introduction: The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. According to the group studies of NHPBEB 2000 four entities are defined: Chronic Hypertension (CH) previous to pregnancy, Gestational Hypertension (GH), Preeclampsia/ Eclampsia (PE/E) and superimposed Preeclampisa/Eclampsia in Chronic Hypertension (PE/E CH). All this entities have different outcomes and require adequate follow-up and specific attitude. Objectives: Review all cases of hypertensive disorders in a two-year period, its incidences, and related maternal and fetal complications. Methods: In a retrospective study, from January 2008 to December 2009, all files related with hypertensive disorders, seen in our department, were reviewed. The statistic analysis was based on Excel 2007. Results: The global incidence of hypertensive disorders was 3.8% (309 cases), with each entity with an incidence of: 40% in CH, 40% GH, 25% PE/E and 7% PE/E CH. In terms of demographic characteristics the majority of the population were caucasian (46%) and black (40%), the mean age was of 31 years (minimum of 12-maximum of 47), and mainly previous Chronic Hypertension and endocrinologic disorders as co-morbidities (Diabetes Mellitus, obesity and thyroid pathology). The fetal/maternal complications were mainly preterm delivery (26.2%), with a low percentage of Abruptio Placentae (1%). Maternal complications were analysed in terms of ICU admissions of 7%, cardiovascular/renal disorders of 1% and maternal bleeding 1%. No maternal death was described. Fetal outcomes were also studied, specifically in terms of birth weight, with an average of 2794 (500–5480 g), apgar index in 1st and 5th minute below seven in respectively, 14% and 3.5%. Conclusion: The incidence of maternal complications in our analysis was lower than described in literature. The incidence of preterm delivery was similar to that reported in other studies, mostly due to late pre-terms (>32 w). Disclosure of interest: None declared doi:10.1016/j.preghy.2012.04.256
PP146. Psychological assessment of renal transplant recipients during pregnancy V.L.L. Belardi Neto *, L.G. de Oliveira, N. Sass (Obstetrics Department, Federal University of São Paulo, São Paulo, Brazil)
Introduction: Although many centers have reported their experience on maternal and perinatal outcomes in renal transplant recipients. Very few information can be found about the psychological aspects that may rise for these patients during pregnancy. Considering the importance of the psychological concerns for this kind of patients, we have developed a protocol to better assist renal transplant recipients during pregnancy and here we show what we have learnt. Objectives: To understand how the maternal concerns are seen from renal transplant recipients in terms of psychological aspects. Methods: Fifteen pregnant kidney transplanted women with an average age of 27.5 years were included in the study. All patients have been investigated beyond the 20th week of pregnancy to delivery. The study is cross-sectional, qualitative, and participation is based on developed phenomenological method. Final data analysis will be done through thematic analysis and hermeneutics of meaning. The only exclusion criteria were the current presence of psychiatric disorders or use of drugs that could influence cognitive and emotional aspects during the psychological evaluation. Results: During the last two years we have observed in these women that all of them are aware of the risks of pregnancy after transplantation. Qualitative aspects were: Pregnant with kidney transplantation show: in relation to pregnancy, the desire to be mothers, to give a son to her husband, to become a healthy person again; they believe that conception is God’s will, they have fear of pregnancy, ambivalence of feelings (fear and happiness). In relation to the graft, they reported fear of baby malformations, fear and anguish of graft loss, still consider it worth the risk of having the baby, and some women name the graft, if it were another infant. In relation to delivery, state anxiety and anguish at the proximity of labor (fear of labor pain, anesthesia, cesarean section, vaginal delivery and the ‘‘psychic pain’’). Conclusion: Pending the final results of this study, we still observed that these patients and their husbands require multidisciplinary monitoring since the beginning of pregnancy. Factors religious, cultural and psychic are involved in the desire to be mothers. Disclosure of interest: None declared
doi:10.1016/j.preghy.2012.04.257
PP147. Prevalence of hypertensive syndromes according to pregnancy age G.M. Dias 1, A.M. Godoi 1, M.R.L.N. Paltronieri 1, 1 1 2 R.P. Soares , S.F. Toledo , M.R.F. Curty , V. Tarricone Jr. 1, M.L.C. David 1, F.L.P. Sousa 1, J.M. Garcia 1,*, R.G.R. Guidoni 1, J.R. Del Sant 3, D.R.A. Porto 3 (1 Obstetrics, UNILUS – Lusíada Foundation/Faculty of Medical Sciences of Santos, Santos, Brazil, 2 Obstetrics, Maternity Hospital Leonor Mendes de Barros, São Paulo, Brazil, 3 Obstetrics, Guilherme Álvaro Hospital, Santos, Brazil)